Depending on the culture, skin color and tone can have different meanings and importance. All individuals have an inherent skin color and type but environmental factors – especially UV exposure – play a major part in the change of one’s skin color/tone over time. However, pigmentation conditions (dyschromia) where there is an abnormal accumulation of pigmentations can be a cause of stress, anxiety and even severe health implications (skin cancer). Here we will discuss only regarding cosmetic pigmentation disorders (hyperpigmentations)
Melanin is the main substance in the skin responsible for skin color. These melanin molecules are present inside small pockets called melanosomes produced by melanocytes. The melanin present in the skin is the main source responsible for human skin color. The activity and interaction with skin cells (keratinocytes) account for differing skin color and skin types in varying ethnicities.
Hyperpigmentation is a common skin condition that occurs when patches of skin become darker than the surrounding skin due to an excess of melanin production. It can affect people of all ages, genders, and skin types. It can also affect any part of the body, including the face, arms, hands, and legs.
Hyperpigmentation can be caused by a variety of factors, including sun damage, hormonal changes, genetics, inflammation, medications, and skin injuries. Excessive sun exposure is a major cause of hyperpigmentation, as it triggers the production of melanin in the skin. (See below image)
Hormonal changes, such as those that occur during pregnancy or menopause, can also lead to hyperpigmentation. Certain medications, such as antibiotics, can also cause hyperpigmentation as a side effect.
The main sign of hyperpigmentation is the presence of dark patches or spots on the skin. These spots can vary in size, shape, and color intensity. They may be flat or raised, and they may or may not be itchy or painful. In some cases, hyperpigmentation may be accompanied by other skin symptoms, such as dryness, flaking, or redness.
There are several types of acquired (non-congenital) hyperpigmentations, each with its own unique characteristics and causes. Some types include:
- Melasma: Melasma is a type of hyperpigmentation that is caused by hormonal changes and typically occurs on the face. It is more common in women than in men, and it often develops in women of childbearing age. It is a chronic condition and difficult to treat.
- Solar Lentigos: These lesions are more common in men of older age and usually are flat and roundish in shape. Sizes can vary and are commonly seen on the face and back of hands. UV radiation is usually the main cause.
- Freckles (ephelides): Freckles are small, flat, circular spots that appear on the skin, usually on areas exposed to sunlight. They are most commonly found on the face (upper cheeks, nose), arms, and shoulders. Freckles are usually harmless and are more commonly seen in fair-skinned individuals. They can vary in size, color, and density, and tend to darken with sun exposure.
- Post-Inflammatory Hyperpigmentation (PIH): This is a type of hyperpigmentation that develops after a type of inflammation (acne, eczema, sunburn) or skin injury. It can also occur after a type of energy- based device (IPL, laser, etc). It is more common in people with darker skin tones.
Hyperpigmentation is usually diagnosed based on a visual examination of the affected skin. Skin analysis devices with special light can allow additional visualization for some pigmentations. In some cases, a skin biopsy may be performed to rule out other skin conditions.
The treatment of hyperpigmentation depends on the type and severity of the condition. Some treatment options include:
- Topical treatment: Over-the-counter and prescription topical creams and ointments containing cysteamine, niacinamide, hydroquinone, retinoids, or kojic acid may be used to lighten dark spots and even out skin tone.
- Chemical peels: Chemical peels involve applying a chemical solution to the skin to remove the outer layer and reveal smoother, brighter skin.
- Laser therapy: Lasers of various wavelengths and pulse durations can reduce melanin in the skin.
- Intense Pulsed Light (IPL): Can reduce some more superficial hyperpigmentations but requires caution in darker skin individuals and those with repeated prolonged sun exposure.
- PDRN: Some studies show reduction in hyperpigmentations after PDRN treatment.
Complete “cure/removal” of hyperpigmentations are theoretically and empirically not possible since melanin will always be part of the skin, but with proper prevention measures and treatment, they can be improved. Recurrence of hyperpigmentations can occur after treatments in clinic and are dependent on multiple factors. Proper application of sunscreen when outdoors and sun avoidance habits are essential in the treatment and prevention of hyperpigmentations.